MDR-TB a challenge in Malawi

Sam Banda Jnr, Malawi

Malawi’s National Tuberculosis Programme (NTP) Programme manager James Mpunga says the problems of multidrug-resistant TB (MDR-TB) is a challenge to the Southern African country compared to Extensively-Drug Resistant TB ( XDR-TB), observing that it is high time new vaccines were developed. He said that with patients not always taking the drugs as directed, MDR-TB and XDR-TB strains have emerged. Mpunga, nevertheless, discloses that Malawi has a problem with MDR-TB and not XDRTB yet.

“Malawi has just concluded its MDR-TB prevalence survey following advice from WHO to establish its prevalence. According to Mpunga, results indicate that the prevalence is as low as 0.4 percent in new smear positive patients and 4.8 percent in patients who have been treated before for TB.

He adds that this translates to between 25 and 67 MDR-TB cases per year. The NTP Program manager also said that so far Malawi has about 40 patients on treatment and that most of them are doing well. Mpunga says following the results of the MDR-TB survey, NTP intensified investigation for MDR-TB in its facilities by testing all retreatment and a proportion of new smear positive patients for MDR-TB.

According to available information, MDR-TB is a form of TB that is resistant to at least the medicines rifampicin (R) and isoniazid (H) and that this makes it more difficult and expensive to treat. Compared to six months for a typical TB case, it can take up to two years to treat MDR-TB and the treatment is 100 times more expensive. Proof of the efficacy of shorter treatment regimens would signal real progress in helping to reduce the time and cost of addressing some cases of MDR-TB and this topic is addressed in several sessions during the conference.

The WHO Global TB Report 2013, released in London last week, reports that 3.6 per cent of newly diagnosed and 20.2 per cent of retreatment cases of TB had MDR-TB. The report states that an estimated 450,000 people developed MDR-TB and 170,000 died from the disease in 2012. It also concludes that less than one-third of the people estimated to have MDR-TB were detected in 2012. However, despite Malawi having cases of MDR-TB, the highest levels of MDR-TB are found in Eastern Europe and Central Asia and treatment success rates for TB remain lowest in the European Region.

The number of MDR-TB cases is increasing even in countries like France, where the overall burden of TB is static or decreasing. “MDR-TB is a real and present threat to global health”, says José Luis Castro, Interim Executive Director of The Union.

He adds: “It puts a greater burden on health systems and budgets, as well as the obvious harm it causes to MDR-TB patients and their families. Cases are found all over the world, irrespective of a country’s overall level of TB prevalence. We all have an urgent and vested interest in identifying MDR-TB and controlling its spread”.